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Efficacy of late concurrent hypo-fractionated radiotherapy in advanced melanoma patients failing anti-PD-1 monotherapy.

晚期同步低分割放疗对单药治疗失败的晚期黑色素瘤患者 anti-PD-1 疗效。

  • 影响因子:6.93
  • DOI:10.1002/ijc.32934
  • 作者列表:"Funck-Brentano E","Baghad B","Fort M","Aouidad I","Roger A","Beauchet A","Otmezguine Y","Blom A","Longvert C","Boru B","Saiag P
  • 发表时间:2020-02-21
Abstract

:Advanced melanoma patients who failed anti-PD-1 therapy have limited options. We analyzed a cohort of 133 advanced melanoma patients receiving anti-PD-1 monotherapy in a referral center between April 2015 and December 2017 and included the 26 patients with confirmed progressive (PD) or stable disease who received additional radiotherapy with an unmodified anti-PD-1 mAb regimen. Tumor evaluations were done on radiated and non-radiated (RECIST1.1) lesions, with abscopal effect defined as a partial (PR) or complete response (CR) outside radiated fields. Primary endpoint was the CR + PR rate in radiated + non-radiated lesions. Secondary endpoints were progression-free survival (PFS), melanoma-specific survival (MSS), and safety. First late radiotherapy, consisting of hypo-fractionated radiotherapy (3-5 sessions, 20-26 Gy), standard palliative radiotherapy, or brain radiosurgery was begun after a median of 6.3 months of anti-PD-1 in 23, 2, and 1 patient(s), respectively. Best response was 8 (31%) CR, 2 (8%) profound PR allowing surgical resection of remaining metastases, and 16 (62%) PD. Abscopal effect was seen in 35% of patients. Median PFS and MSS since anti-PD-1 initiation was 15.2 [95%CI: 8.0-not achieved (na)] and 35.3 [95%CI: 18.5-na] months, respectively. PFS curves seemed to achieve a plateau. We discontinued anti-PD-1 therapy in 9/10 of patients with no residual evaluable disease and observed one relapse after a median of 10 months off anti-PD1-therapy. No unusual adverse event was recorded. Limitations of the study include its retrospective nature and limited size. Hypo-fractionated radiotherapy may enhance anti-PD1 monotherapy efficacy in patients who previously failed anti-PD-1 therapy. Controlled studies are needed. This article is protected by copyright. All rights reserved.

摘要

: Anti-PD-1 治疗失败的晚期黑色素瘤患者的选择有限。我们分析了 2015年4月至 2017年12月在转诊中心接受 anti-PD-1 单药治疗的 133 例晚期黑色素瘤患者的队列,包括 26 例确诊为进展 (PD) 的患者。或病情稳定者,接受未改良 anti-PD-1 mAb 方案的额外放疗。对辐射和非辐射 (RECIST1.1) 病灶进行肿瘤评价,局部效应定义为辐射野外的部分 (PR) 或完全反应 (CR)。主要终点是辐射 + 非辐射病变中的 cr + pr 率。次要终点是无进展生存期 (PFS) 、黑色素瘤特异性生存期 (MSS) 和安全性。首次晚期放疗,包括低分割放疗 (3-5 次,20-26 gy) 、标准姑息放疗、在分别有 23 例、 2 例和 1 例患者的 anti-PD-1 中位数为 6.3 个月后,开始或脑放射手术。最佳反应为 8 例 (31%) CR,2 例 (8%) 深 PR 允许手术切除剩余转移灶,16 例 (62%) PD。35% 的患者可见局部反应。Anti-PD-1 开始后的中位 PFS 和 MSS 分别为 15.2 [95% CI: 8.0-未达到 (na)] 和 35.3 [95% CI: 18.5-na] 个月。PFS 曲线似乎达到平台期。我们在 9/10 没有残留疾病的患者中停止了 anti-PD-1 治疗,并观察到中位治疗后 10 个月复发 anti-PD1-therapy。未记录到异常不良事件。该研究的局限性包括其回顾性性质和规模有限。低分割放疗可能会提高 anti-PD1 治疗失败患者的 anti-PD-1 疗效。需要对照研究。本文受版权保护。保留所有权利。

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影响因子:6.50
发表时间:2020-03-31
来源期刊:Cancer letters
DOI:10.1016/j.canlet.2019.12.039
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